Performance of activities of daily living in multiple sclerosis

Purpose:?To assess the performance of activities of daily living (ADL) in individuals with moderate to severe multiple sclerosis (MS).

Method:?A total of 12 men and 32 women with MS (Expanded Disability Status Scale, EDSS, 6.0?–?8.5) were studied. The performance of personal ADL (P-ADL) and instrumental ADL (I-ADL) was assessed with the Functional Independence Measure (FIM) and the Assessment of Motor and Process Skills (AMPS).

Results:?Twenty-four of the 44 individuals were rated dependent in P-ADL by the FIM motor score, mainly due to limitations in some areas of self-care and in transfers and locomotion. Only three individuals were rated dependent by the FIM cognitive score, indicating no or little cognitive disability. Two thirds of the individuals who were rated independent/modified independent in P-ADL by the FIM were rated dependent in I-ADL by the AMPS. Only the FIM motor score was significantly related to the EDSS score, indicating that ADL performance and disease severity is weakly related.

Conclusions:?Moderate to severe MS reduces the ability to perform both P-ADL and I-ADL. An individual with MS can be independent in P-ADL but still unable to perform I-ADL satisfactorily. Assessments of both P-ADL and I-ADL are advocated to evaluate ADL performance in order to implement appropriate management strategies for individuals with MS.     

Emotional distress and activities of daily living functioning in persons with multiple sclerosis

BACKGROUND: Emotional distress is higher in persons with multiple sclerosis (MS) than in other chronic illnesses. Not known is whether personal attributes of the person with MS and/or the presence of social support will function as mediating and/or moderating variables between emotional distress and adaptation to the illness. OBJECTIVES: Determine if personal attributes and social support function as mediating and/or moderating variables between emotional distress and ADL functioning in persons with MS. METHODS: Secondary analyses of data obtained from 686 persons with MS through self-report measures of emotional distress, personal attributes, social support, and ADL functioning was conducted. Separate mediation and moderation models were tested using stepwise and hierarchical multiple regression. Demographic variables of education, age, and length of MS illness, were controlled in all analyses. RESULTS: Personal attributes and social support functioned as mediator variables between emotional distress and ADL functioning. Additionally, personal attributes and not social support functioned as a moderator. Significant main effects were shown for social support and emotional distress in the moderator model. CONCLUSION: Personal attributes and social support mediated the effects of emotional distress by decreasing its impact on ADL functioning. Personal attributes, as a moderator variable, demonstrated that higher levels were associated with low levels of emotional stress and moderate or lower levels of personal attributes were associated with increased emotional distress suggesting that personal attributes may intervene between emotional distress and ADL functioning by attenuating or preventing a stress appraisal response.     

Activities of daily living and social activities in people with multiple sclerosis in Stockholm County

OBJECTIVE: To describe independence in personal and instrumental activities of daily living (ADL), and frequency of social/lifestyle activities in a population-based sample of people with multiple sclerosis in Stockholm. DESIGN: Population-based survey. SETTING: Data collection in home environment. SUBJECTS: One hundred and sixty-six people with multiple sclerosis. INTERVENTIONS: Data were collected using measurements and structured interviews. MAIN MEASURES: Independence in ADL was assessed by the Barthel Index; independence in personal and instrumental ADL by the Katz Extended ADL Index; and frequency of social/lifestyle activities by the Frenchay Activities Index. RESULTS: The mean age was 51 +/- 12 years in the included 166 people with multiple sclerosis, of whom 71% (n = 118) were women. Fifty-two per cent (n = 85) were independent in personal ADL, 30% (n = 50) in instrumental ADL, and 35% (n = 57) had normal frequency of social/lifestyle activities. Most frequently affected ADL items were cleaning indoors and outdoors transportation (62%, n = 102) and the social/lifestyle items of household maintenance (59%, n = 97), walking outside (59%, n = 97), heavy housework (61%, n = 100), and gardening (68%, n = 112). CONCLUSIONS: ADL and social/lifestyle activities were affected in two-thirds of people with multiple sclerosis in Stockholm. The most affected items were items that could be classified as mobility-related and physically demanding, underlining the importance of developing and using evidence-based exercise treatments and rehabilitation to increase independence in people with multiple sclerosis in Stockholm.     

The impact of slower walking speed on activities of daily living in patients with multiple sclerosis

Aims: To identify the relevance and impact of walking speed (WS) over a short distance on activities of daily living (ADLs) in patients with multiple sclerosis (MS). Methods: An internet‐administered survey of MS patients in four countries was distributed to 605 individuals in 2010. Participants had MS for > 5 years and must have reported difficulty walking as a result of MS. The impact of MS on walking and the effects of WS on ADLs were assessed based upon responses (scored on a scale of 1–10) to five questions and categorised post hoc as: high (8–10), moderate (4–7) or low (1–3) impact/importance. Results: Of the participants who completed the survey (n = 112), 60% were female patients, 63% were aged ≥ 45 years, and 55% had relapsing‐remitting MS. Approximately, half of participants reported a high impact of MS on their general walking ability (46%) and their ability to increase WS over a short distance (55%). Up to 53% of participants reported avoiding ADLs because of concerns about WS; within this cohort, older male patients and patients with secondary‐progressive MS were highly represented. Discussion: These results, which highlight the importance of WS to patients with MS and emphasise the impact of WS on health‐related quality of life and ADLs, underscore the importance of clinical measures of WS, such as the timed 25‐foot walk, in assessing walking in MS patients. Conclusion: Walking speed over a short distance has a significant impact on ADLs for patients with MS.     

Hydration and independence in activities of daily living in people with multiple sclerosis: a pilot investigation

Purpose.?Bladder dysfunction and disability may cause people with multiple sclerosis (pwMS) to limit fluid intake. However, hydration is rarely considered in the multiple sclerosis literature. We investigated the hydration status of people with pwMS and its association with independence in activities of daily living.

Methods.?Twenty-six (six men) pwMS over 18 years old and able to walk with or without an aid took part in the study. Hydration status was measured via urine osmolality, with adequate hydration defined as an osmolality ≤500 (mOsm kg^?1). Independence in daily activities was measured using the Barthel index.

Results.?Mean urine osmolality was 470 ± 209 mOsm kg^?1 and indicated 11 (42%%) participants were not adequately hydrated. Independence in daily activities could partly explain hydration status (R² == 0.209, p < 0.05). Additionally there was a trend for men to be less well hydrated than women.

Conclusions.?The results indicate that some pwMS were not adequately hydrated and that this could be partly explained by disability. Implications of reducing and maintaining fluid levels on function and quality of life in relation to bladder dysfunction and disability in pwMS should be investigated.     

Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living

Kamm CP, Heldner MR, Vanbellingen T, Mattle HP, Müri R, Bohlhalter S. Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living.ObjectiveTo evaluate the prevalence and impact of limb apraxia on manual dexterity and activities of daily living (ADLs) in patients with multiple sclerosis (MS).DesignSurvey.SettingUniversity hospital.ParticipantsConsecutive patients (N=76) with clinically isolated syndrome, relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) or primary progressive multiple sclerosis (PPMS), Expanded Disability Status Scale (EDSS) score from 0 to 6.5, and aged from 18 to 70 years were included.InterventionsNot applicable.Main Outcome MeasuresApraxia was assessed by the apraxia screen of TULIA (AST). The relationship of apraxia with ADLs and manual dexterity was evaluated using a dexterity questionnaire and the coin rotation task, respectively.ResultsOverall, limb apraxia was found in 26.3% of patients (mean AST score ± SD, 7.3±1.3; cutoff <9). Apraxia was significantly correlated with higher EDSS scores, longer disease duration, and higher age with the EDSS being predictive. Furthermore, patients with SPMS and PPMS were more apraxic than patients with RRMS. Finally, limb apraxia was significantly associated with impaired ADLs and manual dexterity.ConclusionsLimb apraxia is a frequent and clinically significant symptom contributing to disability in MS. It should therefore be evaluated and possibly treated, particularly in patients with MS reporting manual difficulties in everyday life.     

The Lawton instrumental activities of daily living scale

By detecting early functional decline, the scale can help nurses with discharge planning. OVERVIEW: Acute illness or a worsening chronic condition can hasten functional decline in older adults. During hospitalization, reduced mobility and other factors may rapidly decrease an older patient's ability to perform activities crucial for independent living, and the effects might be permanent. The Lawton Instrumental Activities of Daily Living (IADL) Scale assesses a person's ability to perform tasks such as using a telephone, doing laundry, and handling finances. Measuring eight domains, it can be administered in 10 to 15 minutes. The scale may provide an early warning of functional decline or signal the need for further assessment. For a free online video demonstrating use of this assessment, go to http://links.lww.com/A246.     

Validation of the advanced activities of daily living scale

The objective was to evaluate the metric properties of the List of Advanced Activities of the Daily Living. A study quantitative was conducted. The sample comprised 200 older adults from the city of Pouso Alegre, Brazil. The following instruments were employed: 1- Questionnaire sociodemographic and health; 2- Vitor Quality of Life Scale for the Elderly (VITOR QLSE); and 3 - List of Advanced Activities in Daily Life – AAVDs. It was verified through the exploratory factorial analysis that the list possesses three denominated domains of Activities of Leisure, Social Activities and Productive Activities. The three-factor solution explained 58.18% of total variance: 30% by the first factor, 18.03% by the second, and 10.14% by the third. The coefficient alpha for the overall scale was 0.80. The list of AADLs presented reliable and valid metric properties to be applied in the elderly.     

Well-being and instrumental activities of daily living after stroke

OBJECTIVE: To explore the relationship between subjective well-being and competence in instrumental activities of daily living after stroke. DESIGN: Cross-sectional with evaluation at six months post stroke. SUBJECTS: Eighty-two patients admitted to an acute stroke unit, of whom 64 were seen at six months. The mean age was 77.5 years, 55% were females and 55% were living alone. MAIN OUTCOME MEASURES: The General Health Questionnaire (GHQ-20 version), a well-being scale, was factor analysed and yielded three dimensions, named 'coping', 'anxiety' and 'satisfaction' that served as main outcomes. RESULTS: Explanatory variables were the four subscales of the Nottingham IADL scale, the Ullevaal Aphasia Screening test, urinary continence and demographics. Structural equation modelling showed that the GHQ dimension 'satisfaction' related significantly to the Nottingham subscale 'leisure activities' (beta = -0.38, p = 0.01), whereas 'coping' was indirectly associated with 'leisure activities' by its correlation with 'satisfaction' (R = 0.26, p = 0.01). None of the outcomes were statistically associated with aphasia, continence or the background variables. CONCLUSION: 'Leisure activities' demonstrated the strongest association to subjective well-being as expressed by the 'satisfaction' dimension. In stroke rehabilitation leisure activities should be addressed when assessing function and planning intervention.     

影响脑卒中患者日常生活活动能力预后的相关因素分析

目的：探讨脑卒中偏瘫患者治疗前后影响日常生活活动（ADL）能力的相关因素。方法：选择可能对脑卒中患者临床预后有影响的因素，以入院康复治疗1个月后改良Barthel指数为标准，进行回顾性和多因素分析。入选病例为17例脑卒中偏瘫患者。结果：康复治疗1个月后患者的ADL能力主要与治疗前的ADL能力呈正相关。与年龄、发病天数、肺部感染、尿路感染、关节挛缩等呈负相关。结论：并发症的发生是脑卒中患者ADL能力恢复的主要影响因素。提示要积极预防并发症，并对患者的家属和护理人员进行康复护理教育。同时强调早期康复治疗对于促进脑卒中患者ADL能力的恢复是十分重要的。     

Predictors of instrumental activities of daily living in community-dwelling older adults

Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.